Quantitative microbial risk assessment and its applications in small water systems: A review

Airborne concentrations of bacteria and mold in Korean public-use facilities: measurement, systematic review, meta-analysis, and probabilistic human inhalation risk assessment

Bioaerosols adversely affect human health posing risk to users of public facilities in Korea. Between October 2021 and May 2022, airborne bacteria and mold were measured in 1,243 public-use facilities across 23 categories. A systematic review and meta-analysis were performed on these and other studies from June 2004 to May 2021, and the non-carcinogenic risks to humans were assessed using Monte Carlo simulations. For bacteria, the maximum 95th percentile concentration was 584.4 cfu/m3 and 1384.8 cfu/m3 for mold. The heterogeneity statistic I2 was over 50% in all facilities, and for subway station bacteria, there was a significant difference according to the measurement method. The 95th percentile of hazard by population group was 8.83 × 10-2 to 3.42 × 10-1 for bacteria, and 1.31 × 10-1 to 3.55 × 10-1 for mold. The probability of a hazard quotient exceeding 1 for some population groups was derived from exposure to bacteria and mold in the air resulting from the use of all public facilities. The most powerful explanatory factor for risk was exposure time to the facility, both within (up to 0.922 for bacteria and up to 0.960 for mold) and between populations (up to 0.543 for bacteria and 0.483 for mold). This study identified populations at risk of bioaerosol exposure in Korean public-use facilities and estimated the influencing factors, highlighting the need for comprehensive improvement in bioaerosol control in public-use facilities.

Two-year Monitoring of Microbiological Water Quality in Small Water Supply Systems: Implications for Microbial Risk Management

Small water supply systems (SWSSs) are often more vulnerable to waterborne disease outbreaks. In Japan, many SWSSs operate without regulation under the Waterworks Law, yet there is limited investigation into microbial contamination and the associated health risks. In this study, the microbiological water quality of four SWSSs that utilize mountain streams as water sources and do not install water treatment facilities were monitored for over 2 years. In investigated SWSSs, the mean heterotrophic plate counts were below 350 CFU/mL, and the total bacterial loads (16S rDNA concentration) ranged from 4.71 to 5.35 log10 copies/mL. The results also showed the consistent presence of fecal indicator bacteria (FIB), i.e., Escherichia coli and Clostridium perfringens, suggesting the potential of fecal pollution. E. coli was then utilized as an indicator to assess the health risk posed by E. coli O157:H7 and Campylobacter jejuni. The results indicated that the estimated mean annual risk of infection and disability-adjusted life years (DALYs) exceeded acceptable levels in all SWSSs for the two reference pathogens. To ensure microbial water safety, implementing appropriate water treatment facilities with an estimated mean required reduction of 5-6 log10 was necessary. This study highlighted the potential microbial contamination and health risk level in SWSSs that utilize mountain streams as water sources, even though the water sources were almost not affected by human activities. Furthermore, this study would also be helpful in supporting risk-based water management to ensure a safe water supply in SWSSs.

Cross-connections in drinking water distribution networks: Quantitative microbial risk assessment in combination with fault tree analysis and hydraulic modelling

Deficiencies in drinking water distribution networks, such as cross-connections, may lead to contamination of the drinking water and pose a serious health risk to consumers. Cross-connections and backflows are considered among the most severe public health risks in distribution networks. The aim of this paper was to provide a framework for estimating the risk of infection from cross-connection and backflow events. Campylobacter, norovirus, and Cryptosporidium were chosen as reference pathogens for this study. The theoretical framework was constructed based on the fault tree analysis methodology. National aggregated cross-connection incident data was used to calculate the probability of a contamination event occurring in Swedish networks. Three risk cases were evaluated: endemic, elevated, and extreme. Quantitative microbial risk assessment (QMRA) was used to assess daily risk of infection for average national estimates. The framework was also evaluated using local data from the Gothenburg network. The daily risk of infection from cross-connection and backflow events in Swedish networks was generally above an acceptable target level of 10^-6 for all reference pathogens and modelled cases; the exception was for the Gothenburg system where the risk was lower than 10^-7. An outbreak case study was used to validate the framework results. For the outbreak case study, contaminant transport in the network was simulated using hydraulic modelling (EPANET), and risk estimates were calculated using QMRA. The outbreak simulation predicted between 97 and 148 symptomatic infections, while the epidemiological survey conducted during the outbreak reported 179 cases of illness. The fault tree analysis framework was successfully validated using an outbreak case study, though it was shown on the example of Gothenburg that local data is still needed for well-performing systems. The framework can help inform microbial risk assessments for drinking water suppliers, especially ones with limited resources and expertise in this area.

A scientometric study on quantitative microbial risk assessment in water quality analysis across 6 years (2016-2021)

Water contamination by microbes is a growing environmental challenge that has exacerbated the apparent scarcity of safe drinking water. To alleviate this challenge, it is important to screen water for pathogens to reduce the risk of contracting waterborne diseases among consumers. The use of the quantitative microbial risk assessment (QMRA) tool to approximate illness possibility from exposure to microorganisms using dose-response models between pathogens and their associated health impacts is, therefore, recommended. The aim of this study was to explore the use of QMRA in water quality assessment using a scientometric approach and data sourced from the Web of Science (WoS) database for the period between 2016 and 2021. Articles were searched in the WoS databases before downloading the content for a bibliometric analysis using the VOSviewer software. Additionally, Microsoft Excel was used to analyze the inter-relationships of the searched results. Journal articles had the highest results from the searched query at 90.6% compared to other forms of output. High-impact journals such as the Science of the Total Environment and Water Research had the highest number of publications at 11.056 and 7.5%, respectively. Keyword analysis showed the multidisciplinary nature of the search query based on the clustered themes. The USA and China showed greater publication output with a total of 51.7% of total publications compared to developing countries due to their high research potential and extensive collaborative networks. A similar trend was evident in the institutional analysis with the University of California, USA, and the Chinese Academy of Sciences being the highest research contributors with 8% of the searched output. The study highlighted the need to extend research inputs to developing countries of Africa and Asia to improve their research and development capacity, productivity and share knowledge on QMRA in water quality assessment.

The occurrence and control of waterborne viruses in drinking water treatment: A review

As the coronavirus disease 2019 continues to spread globally, its culprit, the severe acute respiratory syndrome coronavirus 2 has been brought under scrutiny. In addition to inhalation transmission, the possible fecal-oral viral transmission via water/wastewater has also been brought under the spotlight, necessitating a timely global review on the current knowledge about waterborne viruses in drinking water treatment system - the very barrier that intercepts waterborne pathogens to terminal water users. In this article we reviewed the occurrence, concentration methods, and control strategies, also, treatment performance on waterborne viruses during drinking water treatment were summarized. Additionally, we emphasized the potential of applying the quantitative microbial risk assessment to guide drinking water treatment to mitigate the viral exposure risks, especially when the unregulated novel viral pathogens are of concern. This review paves road for better control of viruses at drinking water treatment plants to protect public health.

Physicochemical, microbiological quality, and risk assessment of water consumed by a quilombola community in midwestern Brazil

The quality of the water consumed by a given community is related to its quality of life. In this sense, this study aimed to evaluate, from the perspective of health risk, the physical, chemical, and microbiological quality of drinking water, in a quilombola community, and the qualitative aspects intrinsic to its use and storage. For this, water samples, collected at the exits of the collective water supply system and from eight cisterns that store rainwater, used for human consumption, were analyzed. The samples were subjected to physical, chemical, and microbiological analysis, including adenovirus (HAdV) and enterovirus (EV). The probability of an individual acquiring infection through water consumption was determined by quantitative microbiological risk analysis using HAdV and Escherichia coli (EC) as reference pathogens. The results showed that the water in the deep tubular well had 270.8 mg/L of total hardness, leading to the rejection of its consumption by ingestion. Alternativity, the people in the community consume rainwater stored in cisterns. For this type of water, the presence of heterotrophic bacteria was found in 75%, total coliform was present in 100%, and Enterococci were detected in 25%. Furthermore, EC was present in 25%, EV in 50%, and HAdV in 100% of the samples. The probability of annual infection with HAdV and EC was, in the worst situation, 100% and 1.3%, respectively. Regarding the qualitative and quantitative aspects, there was a significant positive correlation between the absence of EC and the withdrawal of water from the cistern using a pump and the opposite when the withdrawal was carried out using a bucket or hose. Based on the results found, it is important to carry out actions aimed at improving water quality and, consequently, the quality of life of people living in the study community.

Development of Anti-Virulence Therapeutics against Mono-ADP-Ribosyltransferase Toxins

Mono-ADP-ribosyltransferase toxins are often key virulence factors produced by pathogenic bacteria as tools to compromise the target host cell. These toxins are enzymes that use host cellular NAD⁺ as the substrate to modify a critical macromolecule target in the host cell machinery. This post-translational modification of the target macromolecule (usually protein or DNA) acts like a switch to turn the target activity on or off resulting in impairment of a critical process or pathway in the host. One approach to stymie bacterial pathogens is to curtail the toxic action of these factors by designing small molecules that bind tightly to the enzyme active site and prevent catalytic function. The inactivation of these toxins/enzymes is targeted for the site of action within the host cell and small molecule therapeutics can function as anti-virulence agents by disarming the pathogen. This represents an alternative strategy to antibiotic therapy with the potential as a paradigm shift that may circumvent multi-drug resistance in the offending microbe. In this review, work that has been accomplished during the past two decades on this approach to develop anti-virulence compounds against mono-ADP-ribosyltransferase toxins will be discussed.

Implementation of quantitative microbial risk assessment (QMRA) for public drinking water supplies: Systematic review

In the more than 15 years since its introduction, quantitative microbial risk assessment (QMRA) has become a widely used technique for assessing population health risk posed by waterborne pathogens. However, the variation in approaches taken for QMRA in relation to drinking water supply is not well understood. This systematic review identifies, categorises, and critically synthesises peer-reviewed and academic case studies of QMRA implementation for existing distributed public drinking water supplies. Thirty-nine English-language, peer-reviewed and academic studies published from 2003 to 2019 were identified. Key findings were synthesised in narrative form. The overall designs of the included studies varied widely, as did the assumptions used in risk calculation, especially in relation to pathogen dose. There was also substantial variation in the degree to which the use of location-specific data weighed with the use of assumptions when performing risk calculation. In general, the included studies' complexity did not appear to be associated with greater result certainty. Factors relating to pathogen dose were commonly influential on risk estimates whereas dose-response parameters tended to be of low relative influence. In two of the included studies, use of the 'susceptible fraction' factor was inconsistent with recognised guidance and potentially led to the underestimation of risk. While approaches and assumptions used in QMRA need not be standardised, improvement in the reporting of QMRA results and uncertainties would be beneficial. It is recommended that future authors consider the water supply QMRA reporting checklist developed for the current review. Consideration of the broad types of uncertainty relevant to QMRA is also recommended. Policy-makers should consider emergent discussion on acute microbial health-based targets when setting normative guidelines. The continued representation of QMRA case studies within peer-reviewed and academic literature would also enhance future implementation. Further research is needed on the optimisation of QMRA resourcing given the application context.

Health effects associated with wastewater treatment, reuse, and disposal

This paper highlights the review of scientific literature published in the year 2018 on issues related to health risks associated with human and the general environment on the reuse of wastewater, treatment as well as disposal. The literature review on the above issues divided into number of sections, and these sections include management of wastewater, wastewater reuse with focus on microbial hazards, and chemical hazards. Further, the review also provides some recent research related to wastewater treatment plants, disposal of wastewater, sludge, and biosolids management. PRACTITIONER POINTS: This paper highlights the review of scientific literature published in the year 2018. Review provide issues related to health risks associated with human and the general environment on the reuse of wastewater, treatment as well as disposal. Literature review covers selected papers relevant to the topic.

Using Nodal Infection Risks to Guide Interventions Following Accidental Intrusion due to Sustained Low Pressure Events in a Drinking Water Distribution System

Improving the risk models to include the possible infection risk linked to pathogen intrusion into distribution systems during pressure-deficient conditions (PDCs) is essential. The objective of the present study was to assess the public health impact of accidental intrusion through leakage points in a full-scale water distribution system by coupling a quantitative microbial risk assessment (QMRA) model with water quality calculations based on pressure-driven hydraulic analysis. The impacts on the infection risk of different concentrations of Cryptosporidium in raw sewage (minimum, geometric mean, mean, and maximum) and various durations of intrusion/PDCs (24 h, 10 h, and 1 h) were investigated. For each scenario, 200 runs of Monte Carlo simulations were carried out to assess the uncertainty associated with the consumers’ behavioral variability. By increasing the concentrations of Cryptosporidium in raw sewage from 1 to 560 oocysts/L for a 24-h intrusion, or by increasing the duration of intrusion from 1 to 24 h, with a constant concentration (560 oocysts/L), the simulated number of infected people was increased by 235-fold and 17-fold, respectively. On the first day of the 1-h PDCs/intrusion scenario, a 65% decrease in the number of infected people was observed when supposing no drinking water withdrawals during low-pressure conditions at nodes with low demand available (<5%) compared to no demand. Besides assessing the event risk for an intrusion scenario, defined as four days of observation, the daily number of infected people and nodal risk were also modeled on different days, including during and after intrusion days. The results indicate that, for the case of a 1-h intrusion, delaying the start of the necessary preventive/corrective actions for 5 h after the beginning of the intrusion may result in the infection of up to 71 people.